The American Diabetes Association (ADA) recommends that health care providers consider screening patients at age 45 years and continue screening in 3-year intervals. The ADA also notes that individuals who are overweight or considered to be at higher risk should be screened at a younger age and more frequently.
The ADA recommends routine screening in “high-risk” patients, defined as those with a positive family history of type 2 diabetes (in first- and second-degree relatives), or who are Native Americans, African-Americans, Hispanic Americans, or Asians/South Pacific Islanders.
The ADA also recommends screening for patients who have signs of insulin resistance or conditions associated with insulin resistance, such acanthosis nigricans, hypertension, dyslipidemia, and polycystic ovary syndrome. They note that this advice is based on expert opinion and should be carried out at the discretion of the health care provider.5
CLINICAL COMMENTARY:
Evidence for universal screening is not there
Jim Holt, MD
East Tennessee State University, Johnson City
Many of my patients lead unhealthy lifestyles; they become obese and often develop hypertension, diabetes, dyslipidemia, and heart disease. Further, the incidence of diabetes in the United States has grown by one third in the last decade, and the urge to screen is great. However, the evidence for a significant benefit from screening for diabetes is not there. In fact, the meta-analysis by Harris et al suggests that the number needed to screen in the most favorable group, hypertensives, would still be 900 to prevent 1 cardiovascular event. Furthermore, that estimate results from extrapolation and conjecture; no randomized controlled trial of screening for diabetes has been done. Accordingly, the recommendations by the ADA and USPSTF to screen high-risk patients are likely as aggressive as can be supported at this time—regardless of the drive to do something.